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MONITORING VIM INSTALLATION REPORT <br /> DateCONSTRUCTION <br /> : [ <br /> Lc.w Total Depth <br /> Premise Address: Screen Length (from) (to) _ <br /> ` Filter Pack (from) (to) <br /> Well No.: Bentonite (from) (to) <br /> Grout (from) (to) <br /> Inspector. Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: _ he?ght <br /> Consultant <br /> Geologist APAYE GRCUN[) C}-SZTy-aox <br /> CO MP L_ETfON c4wPL"TicN <br /> C3round Suiact <br /> SPECIAL PERMIT INFO. <br /> pra t <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - ft <br /> SAMPLING �� iQcicn <br /> Holding Temperature <br /> Method ^r- <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> SPOILS <br /> ' MATEALS/DEVELOPMENT <br /> RI <br /> Storage Method <br /> Contamination Noted- (y/ n) Casing type fr. <br /> Storage Location Blank ft. Screen <br /> Slot size <br /> Bags cement <br /> GROUTING r Buckets bentonite 0 �- <br /> O S Bags sand/gravel -` <br /> Depth to water Filter Pack type/size <br /> Mix Ratios Surge Block: - (y/ n) <br /> ipstallation Method Discussed vrith geologist: - (y/ n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />